Use of atypical antipsychotics in the elderly: a clinical review

Gareri, Pietro; Segura-Garcìa, Cristina; Manfredi, Valeria Graziella Laura; Bruni, Antonella; Ciambrone, Paola; Cerminara, Gregorio; Sarro, Giovambattista De; Fazio, Pasquale De

doi:10.2147/cia.s63942

Cited by 70 publications

(47 citation statements)

References 75 publications

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“…34, 35 Moreover, the prophylactic administration of both conventional and atypical anti-psychotics to the older patients is potentially hazardous, with cardiac and metabolic side effects reported because of age-related changes in pharmacokinetics and pharmacodynamics as well as potential adverse drug interactions with other medications. 36 Hence, the evidence to date does not support the use of antipsychotics for prevention of postoperative delirium.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

et al. 2017

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Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

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Section: Discussionmentioning

confidence: 99%

Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

et al. 2017

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“…Antipsychotic drugs (APDs) are commonly prescribed to the elderly for the treatment of psychosis and for the Behavioral and Psychological Symptoms of Dementia (BPSD) (Agid et al 2007; Aupperle 2006; Gareri et al 2014a; Gareri et al 2014b). However, the use of such drugs is problematic because of the increased severity and frequency of side effects in aged populations (Gareri et al 2006; Singh and Hodgson 2010).…”

Section: Introductionmentioning

confidence: 99%

Histone deacetylase inhibitors reverse age-related increases in side effects of haloperidol in mice

et al. 2017

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Background Older patients can be especially susceptible to antipsychotic-induced side effects, and the pharmacodynamic mechanism underlying this phenomenon remains unclear. We hypothesized that age-related epigenetic alterations lead to decreased expression and functionality of the dopamine D2 receptor (D2R), contributing to this susceptibility. Methods In this study, we treated young (2–3 months old) and aged (22–24 months old) C57BL/6 mice with the D2R antagonist haloperidol (HAL) once a day for 14 days to evaluate HAL-induced motor side effects. In addition, we pretreated separate groups of young and aged mice with histone deacetylase (HDAC) inhibitors valproic acid (VPA) or entinostat (MS-275) and then administered HAL. Results Our results show that the motor side effects of HAL are exaggerated in aged mice as compared to young mice and that HDAC inhibitors are able to reverse the severity of these deficits. HAL-induced motor deficits in aged mice are associated with an age- and drug-dependent decrease in striatal D2R protein levels and functionality. Further, histone acetylation was reduced while histone trimethylation was increased at specific lysine residues of H3 and H4 within the Drd2 promoter in the striatum of aged mice. HDAC inhibitors, particularly VPA, restored striatal D2R protein levels and functionality and reversed age- and drug-related histone modifications at the Drd2 promoter. Conclusions These results suggest that epigenetic changes at the striatal Drd2 promoter drive age-related increases in antipsychotic side effect susceptibility, and HDAC inhibitors may be an effective adjunct treatment strategy to reduce side effects in aged populations.

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“…Likewise, it is also a common phenomenon to use sedative–hypnotics and second-generation antipsychotics in order to treat sleeping disorders in dementia 12. However, these drugs often cause significant side effects to the patients, and therefore, they should be avoided, as possible 13. Benzodiazepines are another drug category that is used extensively to treat sleeping disorders.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the efficacy of randomized controlled trials of sensory stimulation interventions for sleeping disturbances in patients with dementia: a systematic review

Dimitriou¹,

Tsolaki²

2017

CIA

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ObjectiveThe current review aims to evaluate the sensory stimulation interventions in terms of reducing sleeping disturbances in patients with dementia. The nonpharmacological interventions seem to be an efficient, inexpensive, and easy tool for family caregivers. Moreover, sleeping disorders increase caregivers’ distress and may lead to hospitalization.MethodsA systematic literature search was performed. Eleven randomized controlled trials have been found. Among these eleven trials, one referred to massage therapy and acupuncture, and the other ten studies referred to bright light therapy.ResultsThe results demonstrated that there are no relevant randomized controlled trials of music therapy, aromatherapy, and multisensory environment/Snoezelen referring to sleeping disturbances. Several studies have been conducted about the effect of the bright light therapy, and there is also another study that combines massage therapy and acupuncture therapy.ConclusionSensory stimulation interventions are inexpensive and practical for dementia caregivers; however, only bright light therapy seems to be useful to reduce sleeping problems in dementia. The other sensory stimulation interventions lack evidence, and there is a strong need for further research.

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Use of atypical antipsychotics in the elderly: a clinical review

Cited by 70 publications

References 75 publications

Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

Histone deacetylase inhibitors reverse age-related increases in side effects of haloperidol in mice

Evaluation of the efficacy of randomized controlled trials of sensory stimulation interventions for sleeping disturbances in patients with dementia: a systematic review

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